First, for those of you who read my last column, I want to give you an update on Professor Noor. I reconnected with him a couple of weeks ago when I was in Denver, and I am happy to report that he has upgraded from a taxi to running a private car service (a nice SUV) and is almost finished with his "reeducation" at a local university. He will likely be back teaching by late this year. The professor's 2 older sons asked him to quit working and let them support the family while he finishes at university, but he will have none of it. He tells them it is his job to provide for the family, as it will be their job to provide for their own families in time. I shared the column with him and he was delighted. He said it reminded him of a saying he learned as a boy, roughly translated as "Do not decide who to talk to based on their social class." Our visit was too short (an airport trip, per usual), so we traded e-mail addresses, and I will look forward to tea with my favorite professor when I next find myself in Denver!!

Now on to the topic at hand, cleaning house. I am in the midst of moving out of the house I have called home for 15 years, and I have had to sort through everything I have accumulated over that time period, which has been both a daunting and enlightening task. Initially, I was reluctant to get rid of things, but as I got started and began to apply some common sense, it became not just easier, but thrilling!! As I sorted through my houseful of stuff, I made several discoveries. Sometimes I found things I had cherished and thought I had lost (my mother's necklace, made from her engagement diamond after my father had passed away). Sometimes I found things I never remembered having, making for delightful, or not so delightful (what was I thinking when I bought this?) surprises. And sometimes, no, make that most of the time, I found that I had held onto things long past the need for them.

Luckily, I was ready to let go of most of my possessions and learned that it feels good to live with less and to simplify. That's what got me thinking about the same principles applied to obstetrics. It seems to me we could all use a good housecleaning every few years in our clinical practice. So I have made up a list of suggestions (all simply my opinion, you need not agree) of what we might consider "trash" and get rid of, and what we should keep, or "treasure" in clinical practice. I will share 3 of each with you.

TRASH

1. Arguing over the NICHD nomenclature. Isn't it time to let this one go? The definitions aren't perfect (what is?) but by arguing continually over the "what do I call it" in electronic fetal monitoring, clinicians are missing an opportunity to answer the more important questions-questions like "what does it mean" and "what should we do about it." Let us save the angst for the important questions and have the wisdom to recognize that there is much more to fetal monitoring than terminology. Time to trash the trash-talk, don't you think?

2. Using oxytocin aggressively and without respect for basic physiology. Needs no further explanation. Anything other than a physiologic approach to oxytocin is toxic waste-do not keep it in your house (hospital).

3. The football game approach to second stage. This one appears to be hard to get rid of, but I know we can do it if we just try. The Association for Women's Health, Obstetric and Neonatal Nurses has a new monograph out on the subject. Get it. Read it. Apply it. And toss the holding-the-breath, 3-pushes-per-contraction, count-to-ten-you (or the family) yelling-at-the-mother (do women lose hearing in second stage? I think not). This dress was outdated in the eighties by physiology fashionistas with PhDs; it has not fit in years, and should not even be in the Good Will giveaway pile. Toss it. Seriously, throw it out today and do not look back.

TREASURE

1. Our ability to collaborate within and among disciplines. We had it when I started. And I did not even walk uphill in the snow to school (both ways). Seriously, back in 1979, when I began as a nurse in labor and delivery there was no need to teach teamwork, it was a fact of life because we were so short-staffed. Chairs of departments answered phones, mopped delivery room floors (I am not kidding), and taught residents to ask the charge nurse before calling the attending. Like my mother's necklace, we went through a time when this collaborative approach seemed to be lost, but today we see it emerging again (OK, maybe not the floor-mopping) as the patient safety movement. We should definitely consider it a valuable treasure.

2. The doctors that we work with daily. Yes, the docs. Sure, there are a few outliers that make us wonder why we (or more often, they) went into the business. But really, those are truly the outliers. Over the years I have worked with some of the best obstetricians, family practitioners, perinatologists, pediatricians, and neonatologists in the country, if not the world. And they have listened, they have come when called, they have respected my expertise and my opinions, and they have done so with the greatest courtesy and the obvious belief that safety, not ego, comes first.

3. Who we are. We are smart, dedicated professionals. We are self-aware. We are willing to read, attend conferences (even when the hospital won't or can't pay), join our professional organizations, and show up everyday that we are committed to helping families have safe births. We are hand-holders, brow-wipers, back-rubbers, and labor-whisperers, who also happen to know how to handle an arterial line, a crash section, and the terrible grief of an infant lost. These are our professional jewels, our heirloom pieces. Wherever we move, whatever house we occupy, these are the things we will always take with us. These we will polish, protect, and preserve.

I am finally packed and ready to go. I look forward to my new home and will love and keep dear the memories and mementos of my past. I look forward to continuing growth professionally, especially now that I am clearing out the clutter. I hope each of you will take some time this year to sort through your own professional "house" and make your own trash/treasure lists. It can be very thought provoking, and let us face it, it is easier than real housecleaning!!

-Lisa A. Miller, CNM, JD

President Perinatal Risk Management and Education Services, Chicago, Illinois